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General NPI Number Information
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NPI Number | 1194033688
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Entity Type | Organization
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Legal Business Name | INTEGRA MEDICAL SERVICES,INC.
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Dates
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Enumeration Date | 09/17/2010
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Last Update Date | 09/17/2010
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Provider Practice Location Address
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Address Line | 3312 W 111TH ST UNIT A
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City | CHICAGO
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State | IL
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Zip | 60655-2747
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Country | US
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Telephone | 877-437-6141
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Fax | 866-205-6594
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Provider Business Mailing Address
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Address Line | 3312 W. 111TH ST. UNIT A
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City | CHICAGO
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State | IL
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Zip | 60655-2747
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Country | US
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Telephone | 877-437-6141
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Fax | 866-205-6594
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. GLENN LEONG MANGUERRA
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Credential | R.N
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Telephone | 773-934-3977
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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